| NPI | 1558881433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-02016) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: KS 15-02016) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: KS 15-02016) | |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2023-12-08 |